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Getting to a comfortable retirement is a leading financial goal for most physicians, even for younger dermatologists who may continue to practice for many years. To reach this goal, physicians may use several different planning tools throughout their careers. In this article, we will examine six leading retirement planning tools most often utilized by doctors and outline the basic rules that govern their use.

1. Qualified Retirement Plans (QRPs) for Employed Physicians

Dermatologists who are employed and receive a W-2 can often participate in their employer’s retirement plan, which allows them to defer income by contributing to the plan.

For example, 401(k) plans are one type of QRP, and are the most common option offered to physician employees of for-profit entities. The 403(b) plans work the same as 401(k)plans, but they are offered by government and nonprofit healthcare organizations.

Government-sponsored 457(b) plans are offered by state and local government health care organizations. Physicians can defer funds into the plan on a pre-tax basis in addition to the money they contribute to a 403(b) plan.

Non-government organization 457(b) plans, or NGO 457 plans, present a special risk for unwary physicians saving for retirement. While these plans also allow for pre-tax contributions and tax-deferred growth, they only gain these tax benefits due to a “substantial risk of forfeiture” imposed by the Internal Revenue Service. Doctors who hold these plans can lose everything if the sponsoring employer goes bankrupt. While account balances from one non-government 457(b) can usually be rolled over to another non-government 457(b) plan, they cannot be rolled over to an IRA or any other type of plan.

A 401(a) plan is a QRP normally offered by government agencies, educational institutions, and non-profit organizations, rather than by corporations. These plans are usually custom-designed and can be offered to key employees as an added incentive to stay with the organization. The employee contribution amounts are normally set by the employer, and contributions can be pre- or post-tax. The employer has a mandate to contribute to the plan as well.

2. Qualified Retirement Plans for Dermatologists in Private Practice

A QRP for a private practice may be in the form of a defined benefit plan, profit sharing plan, money purchase plan, or 401(k). Properly-structured plans offer a variety of benefits: you can fully deduct contributions to a QRP, funds within the QRP grow tax-deferred, and (if non-owner employees participate) the funds within a QRP enjoy superior asset protection.

In our experience, we find that nearly all physicians in private practice participate in QRPs. The tax deduction is hard to resist. For many physician practice owners, however, the cost of contributions for employees, potential liability for mismanagement of employee funds, and the ultimate tax costs on distributions at least suggest that it would make sense to investigate another type of plan (that hedges the QRP) as an additional savings vehicle. For many, tool number three provides that tax hedge.

3. Non-Qualified Plans for Dermatologists in Private Practice

Many private practice physicians want to save significantly for retirement but are limited by the funding rules of QRPs. Others, per above, are interested in a plan that hedges against their QRP and can be accessed tax-free in retirement. Non-qualified plans (Non-Q Plans) can be the solution for many dermatologists. Because these plans are not subject to QRP rules, Non-Q Plans do not have to be offered to any employees. Further, even among the physician-owners, there is total flexibility. For example, one doctor can contribute a maximum amount, the next partner could contribute much less, and a third physician could opt out completely.

The main drawback to Non-Q Plans is that contributions are never tax deductible. However, like a Roth IRA, they can be structured for tax-free growth and tax-free access in retirement. As such, Non-Q Plans can be an ideal long-term tax hedge against a QRP. Beyond these general ground rules, there is tremendous flexibility and variation with Non-Q Plan designs.

4. Benefit Plans for Self-Employed Physicians/Outside Businesses

Physicians who receive income reported on Form 1099 (including doctors who “moonlight,” work locum tenens, or consult/speak in the healthcare industry) and self-employed physicians have other options to help save for retirement.

A SEP-IRA is a traditional IRA established under a Self-Employed Pension Plan document (often the Form 5305-SEP). Under the 2019 limits, physicians can contribute the lesser of $56,000 or 25 percent of compensation. In addition, physicians with a SEP may still be able to contribute to a separate Traditional IRA or Roth IRA. Like other traditional IRAs, account balances can grow tax-deferred, and are taxed at ordinary income rates when distributed.

5. After-Tax IRAs

A traditional IRA allows doctors to defer up to $6,000 per year ($7,000 per year if over age 50) into the account, under the 2019 limits. Physicians who are not covered by a workplace retirement plan may deduct pre-tax contributions while those covered at work can make non-deductible or partially-deductible contributions, depending on their earned income and filing status.

Many physicians implement a “backdoor Roth IRA” by first contributing to a Traditional IRA and then converting the Traditional IRA to a Roth IRA. (Note: This tactic requires careful planning to avoid unnecessary taxation. Work with an experienced advisor on this.)

6. Life Insurance as a Retirement Plan

Above, we explained that Roth IRA contributions are made after-tax, but then the balances grow tax free and can be accessed tax free in the future. Would you be surprised to learn that, if managed properly, a permanent life insurance policy can act the same way? As we described in an earlier article, “permanent” life insurance includes whole life, universal life, variable life, and equity indexed life insurance policies. Regardless of the type of insurance product, the cash value of such policies grows tax free and can be accessed tax free during the insured’s life.


The number one financial goal of nearly all physicians, including dermatologists, is a retirement on their terms, and the six retirement tools discussed in this article can play significant roles in achieving this goal. If building your retirement wealth is an important goal for you, an experienced advisor can help you investigate retirement planning alternatives and determine the best option(s) for you, your family, and your dermatology practice. The authors welcome your questions.

To receive free copies of Wealth Protection Planning for Dermatologists and Wealth Management Made Simple, text PRDERM to 555-888, visit and enter promotional code PRDERM at checkout, or call 877-656-4362. Books are available in hard copy or ebook formats for Kindle and iPad.

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